Esophageal Intubation: A Review of Detection Techniques

Although the first reported oral intubation of the human trachea occurred in 1878 (l), the procedure did not become standard practice until many years later. It is now a routinely performed procedure, one of the first techniques to be encountered by the anesthesia trainee. It is performed by individuals of different backgrounds and levels of training in the operating suite, emergency room, intensive care unit, hospital ward, and in the field. However, the frequency of tracheal intubation in modern anesthetic practice belies its importance, and the ability to accurately evaluate proper endotracheal tube position is crucial. A review of various anesthetic-related morbidity and mortality statistics (2-8) indicates that unrecognized esophageal intubation remains a problem, even among anesthesia personnel, a medical population specifically trained in such a procedure. An analysis of anesthetic accidents reported to the Medical Defence Union of the United Kingdom from 1970 to 1978 revealed that nearly half the cases resulting in death or cerebral damage were due to faulty technique (2). The technique most often identified as the source of mishap was tracheal intubation, with inadvertent esophageal tube placement the usual problem (2). Another review of anesthesia-related medical liability claims in the United Kingdom from 1977 to 1982 listed esophageal intubation as a ”main cause” of accidents leading to death or neurologic